If you are a provider, fax a New Appointment Request Form (NARF) (PDF) (DOC) to 206-985-3121 or 866-985-3121 (toll-free).

No pre-referral workup is required for most conditions. If you have already done a workup, please fax this information as well as relevant clinic notes and the NARF to 206-985-3121 or 866-985-3121 (toll-free).

What is symbrachydactyly?

Hand of a child with short fingers from symbrachydactyly.

Babies with symbrachydactyly (sim-BRA-chi-DAK-til-ee) are born with short fingers, which may be webbed, or they are missing fingers. Usually this happens on only 1 hand, and the other hand looks typical.

Some of the finger bones (phalanges, fah-LAN-jeez) may be smaller than is typical, and the fingers may be stiff. In more serious cases, the fingers are missing bones. If the fingers have no bones at all, your baby may have little stumps of skin and soft tissue (nubbins) where the fingers would be.

Most babies with symbrachydactyly have a complete thumb, but sometimes the thumb is short or missing. The long bones that connect the fingers to the wrist (metacarpals) may be short, too. Some babies have a short forearm as well. The muscles, tendons and ligaments in the hand are also affected.

Symbrachydactyly in children

When a baby’s hands begin to form in the womb, they are shaped like mittens or paddles. Then the fingers divide. In babies with symbrachydactyly, the fingers (and sometimes the hand and arm) don’t fully form during this time. This may happen because the area doesn’t get enough blood flow or because of some other problem with the tissue. It’s not caused by anything the mother did or did not do while she was pregnant.

Most children with this condition can use their hands well enough to do all the usual things children do. Even if their smaller hand doesn’t work well on its own, they can use it to assist their other hand.

Symbrachydactyly isn’t common. It happens in about 1 in 32,000 babies. It’s not passed down in families (inherited). If you have a child with symbrachydactyly, you are not at any greater risk of having another child with the condition.

Symbrachydactyly at Seattle Children’s

Our doctors, surgeons, nurses and occupational therapists have lots of experience treating symbrachydactyly. Each year we see babies with this condition in our clinics. We create a tailored treatment plan for each of them to get the best results.

The compassionate experts you need are here

For many children, treatment means surgery – sometimes highly complex surgery – to improve how their hand works and looks. Our surgeons are experienced at performing this type of surgery in children.

When needed, our Rehabilitation Program provides occupational therapy to help children with symbrachydactyly gain the best possible use of their hands.

We have the largest group of board-certified pediatric radiologists in the Northwest. Our radiologists have special expertise using ultrasound to look for bone and joint changes so we can work with your child to help prevent future problems. If your child needs imaging that uses radiation, we use the lowest amount possible to produce the best image. We also have a 3D low-dose radiation X-ray machine, called the EOS, for safer full-body 3D images.

Symptoms of Symbrachydactyly

Babies with symbrachydactyly may have 1 or more of these:

Short fingers in which some bones are smaller than normal or are missing

Diagnosing Symbrachydactyly

If your child is born with short or missing fingers, the doctor will examine your child carefully. During the exam, the doctor will check to see how complex the condition is and how it might affect your child’s use of their hand.

Your child may need an X-ray or other type of imaging scan to tell whether any phalanges are missing, whether the metacarpals are short and how other tissues, such as muscles and tendons, are affected.

Treating Symbrachydactyly

Most children with symbrachydactyly can do all the usual things children do because they have enough hand function or gain enough function with treatment.

Mild symbrachydactyly may not need any treatment at all. Some children need occupational therapy or surgery to improve use of their hand. Your child’s doctors will work with you to tailor treatment to your child’s needs.

Occupational therapists (OTs) teach your child skills to take care of themselves, such as how to eat and how to get dressed. They also work with your child to develop fine motor skills, such as writing.

Even if your child’s smaller hand doesn’t work well on its own, your child can use it to assist their other hand. OTs help children learn the best ways to use their hands together.

Many tools (adaptive devices) may help your child do things on their own. OTs suggest these tools and teach your child how to use them.

Phalangeal transfer. The surgeon removes bones (phalanges) from your child’s toes and places them inside the skin nubbins on your child’s hand. This way your child can grip by pressing their thumb against their fingers. Only 1 bone is taken from each toe, which doesn’t impair your child’s walking.

Distraction. Later, after the bones of a phalangeal transfer have grown, the surgeon may be able to lengthen these bones. The surgeon cuts through the bone. Metal pins and rods are used to move the pieces of bone away from each other slowly over many weeks. This is called distraction. The surgeon fills the gap with a bone graft, often taken from the child’s hip.

The timing of surgery varies. Your child’s team will work with you to make a plan based on your child’s needs. After any surgery, the doctor will want your child to come back for follow-up visits to make sure they are healing well.

If you are a provider, fax a New Appointment Request Form (NARF) (PDF) (DOC) to 206-985-3121 or 866-985-3121 (toll-free).

No pre-referral workup is required for most conditions. If you have already done a workup, please fax this information as well as relevant clinic notes and the NARF to 206-985-3121 or 866-985-3121 (toll-free).

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Seattle Children’s complies with applicable federal and other civil rights laws and does not discriminate, exclude people or treat them differently based on race, color, religion (creed), sex, gender identity or expression, sexual orientation, national origin (ancestry), age, disability, or any other status protected by applicable federal, state or local law. Financial assistance for medically necessary services is based on family income and hospital resources and is provided to children under age 21 whose primary residence is in Washington, Alaska, Montana or Idaho.

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